Lippincott Nursing Pocket Card - August 2023

Integumentary Assessment



The integumentary system includes the skin, hair and nails. Make sure there is adequate lighting and have the patient change into a gown. Have a small tape measure or magnifying glass available to measure or examine lesions more closely.


Optimal Patient Positioning

  • If possible, examine the patient first seated, then standing; or examine the patient while supine, then prone.
  • Ask permission to expose any areas covered by the gown before adjusting the gown to see each area.
  • Consider patient comfort, modesty, and having a chaperone present during these examinations. 
  • Use good lighting and magnifying lens, when needed.

Exam Methods

  • Inspection
    • To ensure that all areas are examined, consider this order for inspection.
      • While patient is seated
        • Assess the hair, noting the distribution, texture, and quantity.
        • Use your fingers or cotton-tipped applicator to separate the hair and examine the scalp from one side to the other.
        • Inspect the head and neck, including forehead, eyebrows, eyelids, eyelashes, conjunctivae, sclerae, nose, ears, cheeks, lips, oral cavity, chin, and beard.
        • Have the patient lean forward to assess the upper back.
        • Inspect the shoulders, arms, and hands, including the fingernails.
        • Inspect the anterior chest and abdomen, followed by the anterior thighs and legs.
        • Assess the feet and toes including the soles, interdigital areas, and toenails.
      • While patient is standing
        • Inspect the lower back, followed by the posterior thighs and legs.
        • Lastly, inspect the breasts, axillae, and genitalia including hair in the axillae and pubic area.
  • Palpation
    • While inspecting the integumentary system, palpate the fingernails and toenails, and also any lesions to determine texture, firmness, and scaliness.


  • Pallor indicates anemia. Cyanosis can indicate decreased oxygen in the blood or decreased blood flow in response to a cold environment. Jaundice, or yellowing of the skin, results from increased bilirubin.
  • Longitudinal bands of pigment on the nails are normal in people with darker skin.
  • Special considerations for darkly pigmented skin:
    • Erythema may appear dark brown, instead of pink or red
    • Eczema may appear as scaly lesions with grayish or dark brown hue
    • Wheals may appear lighter in color
    • Dry skin may appear whitish or ashy and/or a reduction in shininess of skin
  • If performing a routine physical assessment, integrate aspects of the integumentary assessment into that examination. For example, when auscultating the lungs posteriorly, fully assess the back at that time.
  • Teach the patient about regular skin self-examination and the ABCDE-EFG method for assessing moles.
  • Document your findings using the correct terminology to describe skin lesions.
Armstrong, C.A. (2023, May 8). Approach to the clinical dermatologic diagnosis. UpToDate.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.